N.C. Attorney General Josh Stein at a Tuesday press conference on the opioid epidemic.

Attorney General Josh Stein is joining 40 other state attorneys general in an expanded investigation of five opioid manufacturers and three opioid distributors, he announced in a Tuesday press conference.

The investigation will look into how the companies may have contributed to the national opioid epidemic through their business, advertising and marketing practices.

Approximately 1,600 North Carolinians died of drug overdoses last year, making it the number one cause of accidental death in the state, Stein said. That’s nearly four a day. According to the latest data, one in 100 newborns in the state begin life with opioid dependency.

That means more funding, more education and treatment, Stein said – but it also means looking carefully into the origins of the epidemic.

“As millions of Americans were becoming addicted to prescription pain killers and communities were struggling to respond to this crisis, drug companies were reaping enormous profits,” Stein said.

“Our investigation will determine whether the drug manufacturers and drug distributors unlawfully created and fueled this crisis,” Stein said. “And if they did, I will hold them accountable.”

The expansion of the investigation, which began earlier this summer, will include Purdue Pharma, Endo, Janssen, Teva/Cephalon, Allergan and distributors AmerisourceBergen, Cardinal Health and McKesson.

Stein was joined at Tuesday by a half-dozen people with expertise in and personal knowledge of the opioid epidemic and its costs. They included Nashville, NC Police Chief Thomas Bashore, N.C. Secretary of Health and Human Services Dr. Mandy Cohen and Dr. Ashwin Patkar of Duke University Medical Center.

Steve Shelton, a Guilford County man who lost his 27-year-old son Caleb to an overdose last year, was also on hand to tell his story. He was joined by Ashley Fabrizio, a mother of two who developed a debilitating, years-long opioid dependence after a cheerleading accident at age 16.

“Parents carry the emptiness of these losses forever,” Shelton said. “There is never any closure.”

Shelton’s son Caleb began taking prescription pain killers after sports injuries and a motorcycle accident, he said. Before long his promising life – which included a a 2-year old son – was given over entirely to pain relief, the managing a growing substance abuse disorder and a depression he couldn’t escape.

Shelton called his son’s death “unimaginable, tragic and avoidable.”

Fabrizio said her story was similar – she was prescribed Vicodin and Percocet after breaking an ankle cheerleading in high school. She was given repeated refills – 50 pills at a time – with no questions and no attention paid to whether she was developing a dependence. In college she progressed to buying OxyContin from a friend of her brother, who was also struggling with addiction. Though she got help and recovered, she later relapsed after the birth of her second child. By that time her fiance, who had developed his own pill dependence, had begun shooting heroin.

She was lucky to survive and to now be in recovery, she said.

Secretary Cohen said Fabrizio’s story is, unfortunately, too common.

“We arrived here at this crisis on a path paved with good intentions,” Cohen said.

As a physician herself, she said, she saw firsthand the medical culture of the last few decades that encouraged doctors to manage patients’ pain and didn’t pay enough attention to the consequences of the medication prescribed.

Since 1999 more than 13,000 North Carolinians have died over opioid overdoses, Cohen said – an upward trend that continues.

“We’re not going to get out of this crisis overnight,” Cohen said. It will take government, law enforcement and the medical community working together — and it will take a commitment to treating drug dependence as the medical issue it is.

“We need to use every tool in our toolbox to combat this crisis and turn the tide, Cohen said.

When lawmakers approved the final state budget in June, many expected the bipartisan concern would lead to significant funding to combat the opiate problem.

“We know that there is $4 billion dollars sitting with the federal government to allow us to increase access to insurance coverage that we are not taking advantage of right now,” Cohen said. “And I think those two things are linked. Our ability to fight the opioid crisis is not as good as if we had expanded access to insurance coverage – and that plays and important role.”

“I’m happy for the small amount of money that we got this year to do some treatment – we got some federal grant dollars,” Cohen said. “But this is more than just Band-Aids with grant dollars. This is, ‘How can we provide help for our whole state on an ongoing basis?'”

Congress is considering diminishing the amount of money North Carolina gets through Medicaid, Stein said – which would be a huge step backward.

Police Chief Thomas Bashore of Nashville created the HOPE Initiative, which helps those struggling with substance abuse get treatment through the Nashville Police Department without fear of arrest. He said health care and funding for treatment programs have been a huge issue for his department’s efforts.

“In my program 90 to 95 percent of the individuals who we see don’t have insurance,” Bashore said. “Obviously that’s a problem and I would hope people can see that.”

State funding for more treatment facilities is also badly needed, he said.

“As we see more programs and more law enforcement agencies come on board with things like the HOPE Initiative, we need more beds in these treatment facilities for that immediate need,” Bashore said. “Everybody has a different path to recovery, but they have to have the chance to start somewhere.”